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September 09, 2007

Heads Up: Traumatic Brain Injury ("TBI") and PTSD

There's a really excellent -- as in relatively comprehensive, considering -- article in today's USA Today called "Doctors Face Rash of Brain-Damaged Vets." Unfortunately, what doctors are finding is that the two "signature wounds" of the current wars -- traumatic brain injury ("TBI") and post-traumatic stress disorder ("PTSD") can often occur together. And even more unfortunately, the presence of both in the same person can complicate matters quite a bit.

As the article states, "Odd as it may seem, brain injury can protect against PTSD by blurring awareness of what happened. But as memory improves, emotional problems can emerge..."

Certain symptoms that show up initially, such as headache, dizziness and balance problems -- perhaps more due to the TBI -- actually subside over time; whereas other symptoms -- including memory problems and 'irritability' -- probably more part of the PTSD complex of symptoms -- actually increase over time, according to data cited in the article, from a study conducted by Walter Reed Army Medical Center.

Current -- and future -- treatment programs are going to need to be able to effectively treat combat veterans who have undergone TBIs in such a way that they can also catch emerging PTSD, even if it comes out after the brain injury has optimistically "resolved." Also dangerous: the fact that overall, occupational therapy needed to treat brain injury has been downgraded at many private hospitals and outsourced to nursing homes, according to an insider in the field. With a growing number of combat veterans who've been exposed to TBIs now returning to civilian life, it's going to be important to care for them both within the VA system and also within the private hospital setting. Affording treatment is going to be another ballooning cost of the war effort, but one that's crucial for us to get behind, in order to ensure that veterans are treated effectively.

Another issue that the article brings up is the number of times deployed military have been exposed to TBIs. The article mentions vets experiencing at least "an explosion a month." A few years back, doctors found that high school and college football players who experienced two or more concussions on the field in succession -- separated by days or even weeks -- were at much greater risk from serious injury, including death -- than had ever been thought. And they started to talk about the cumulative effect of concussions, and how difficult it is for the body to heal from that. Essentially, what combat veterans are going through now is the same thing: exposure to explosions, that causes an underlying stress on the brain, followed up sometimes by direct injury, such as TBIs. Now we need to add into the mix PTSD as well, which can show up later, thanks to the body's own capacity to focus first on the TBI.

Unraveling the complexities of this increasingly all-too-common scenario is going to take a lot of work, and patience, on everyone's part. Even physicians in private practice are not used to seeing the level of TBIs that returning vets will be bringing into their practices. The Centers for Disease Control ("CDC") even has an article on its website for doctors about recognizing and treating TBIs, but it doesn't yet reference the combat connection...Their handout, which might be worth vets and their families reading to familiarize themselves better with the subject, is called "Heads Up: Brain Injury in Your Practice - A Tool Kit for Physicians."